Professional Documents
Culture Documents
Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.
I, REMEDIOS NAVARRO CAMPOSANO , Filipino, born on 01/17/1939 , a duly registered voter in Precinct No.
of Barangay BARANGAY 66-A , City/Municipality of TACLOBAN CITY , Province of LEYTE , do HEREBY
APPLY FOR: (Check for appropriate box/es)
IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at TACLOBAN
CITY , Province of LEYTE , Philippines
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability
REMEDIOS Assisted by :
First
Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province BULACAN
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 27 6 In the Philippines 82
Name of Spouse, If married
PROFESSION / OCCUPATION
GORGONIO G. CAMPOSANO
TIN
REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am registered in a
precinct of another City/ Municipality/District in the Philippines. Further, I give consent to the
processing of the Information stated herein by the Commission on Elections for registration, election
and other purposes as may be provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367
and R.A. No. 10173 also known as the Data Privacy Act of 2012. Left Thumb Right Thumb
Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3
Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.
I, REMEDIOS NAVARRO CAMPOSANO , Filipino, born on 01/17/1939 , a duly registered voter in Precinct No.
of Barangay BARANGAY 66-A , City/Municipality of TACLOBAN CITY , Province of LEYTE , do HEREBY
APPLY FOR: (Check for appropriate box/es)
IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at TACLOBAN
CITY , Province of LEYTE , Philippines
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability
REMEDIOS Assisted by :
First
Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province BULACAN
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 27 6 In the Philippines 82
Name of Spouse, If married
PROFESSION / OCCUPATION
GORGONIO G. CAMPOSANO
TIN
REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am registered in a
precinct of another City/ Municipality/District in the Philippines. Further, I give consent to the
processing of the Information stated herein by the Commission on Elections for registration, election
and other purposes as may be provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367
and R.A. No. 10173 also known as the Data Privacy Act of 2012. Left Thumb Right Thumb
Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3
Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
Reference No. : CEF13747018-29000900202122778902 Generated on 22 September 2021 00:29 (Philippine Standard Time)
Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.
I, REMEDIOS NAVARRO CAMPOSANO , Filipino, born on 01/17/1939 , a duly registered voter in Precinct No.
of Barangay BARANGAY 66-A , City/Municipality of TACLOBAN CITY , Province of LEYTE , do HEREBY
APPLY FOR: (Check for appropriate box/es)
IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at TACLOBAN
CITY , Province of LEYTE , Philippines
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability
REMEDIOS Assisted by :
First
Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province BULACAN
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 27 6 In the Philippines 82
Name of Spouse, If married
PROFESSION / OCCUPATION
GORGONIO G. CAMPOSANO
TIN
REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am registered in a
precinct of another City/ Municipality/District in the Philippines. Further, I give consent to the
processing of the Information stated herein by the Commission on Elections for registration, election
and other purposes as may be provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367
and R.A. No. 10173 also known as the Data Privacy Act of 2012. Left Thumb Right Thumb
Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3
Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
Ref. No. : CEF13747018-29000900202122778902 Generated on 22 September 2021 00:29 (Philippine Standard Time)
Annex "B"
SUPPLEMENTARY DATA
(Persons with disabilities/ Senior Citizens with disabilities/ Indigenous Cultural Communities)
PROVINCE LEYTE
TYPE(S) OF ASSISTANCE NEEDED ON ELECTION DAY
Communication Assistance
Are you a member of any Indigenous People (IP) or
Indigenous Cultural Communities (ICC)? Accessible Precinct
Visual Assistance
None
YES NO
If yes, please indicate the Name of IP/ ICC Community PWD/SENIOR CITIZEN
Are you willing to vote in PWD/ SC Precinct No.
accessible polling place?
I, CHERRY MAE L. CAMPOSANO , a resident of BLK O LOT 153 SCANDINAVIAN VILLAGE , whose name and
signature appear below, hereby bind myself and declare under oath:
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ______, 20__ at
______________________, Province of _____________________.
SUBSCRIBED AND SWORN to before me this ____ day of _______ at ______________________, Philippines.
Election Officer
Signature over Printed Name
Ref. No. : CEF13747018-29000900202122778902 Generated on 22 September 2021 00:29 (Philippine Standard Time)
Annex "B"
SUPPLEMENTARY DATA
(Persons with disabilities/ Senior Citizens with disabilities/ Indigenous Cultural Communities)
PROVINCE LEYTE
TYPE(S) OF ASSISTANCE NEEDED ON ELECTION DAY
Communication Assistance
Are you a member of any Indigenous People (IP) or
Indigenous Cultural Communities (ICC)? Accessible Precinct
Visual Assistance
None
YES NO
If yes, please indicate the Name of IP/ ICC Community PWD/SENIOR CITIZEN
Are you willing to vote in PWD/ SC Precinct No.
accessible polling place?
I, CHERRY MAE L. CAMPOSANO , a resident of BLK O LOT 153 SCANDINAVIAN VILLAGE , whose name and
signature appear below, hereby bind myself and declare under oath:
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ______, 20__ at
______________________, Province of _____________________.
SUBSCRIBED AND SWORN to before me this ____ day of _______ at ______________________, Philippines.
Election Officer
Signature over Printed Name
Ref. No. : CEF13747018-29000900202122778902 Generated on 22 September 2021 00:29 (Philippine Standard Time)
Annex "B"
SUPPLEMENTARY DATA
(Persons with disabilities/ Senior Citizens with disabilities/ Indigenous Cultural Communities)
PROVINCE LEYTE
TYPE(S) OF ASSISTANCE NEEDED ON ELECTION DAY
Communication Assistance
Are you a member of any Indigenous People (IP) or
Indigenous Cultural Communities (ICC)? Accessible Precinct
Visual Assistance
None
YES NO
If yes, please indicate the Name of IP/ ICC Community PWD/SENIOR CITIZEN
Are you willing to vote in PWD/ SC Precinct No.
accessible polling place?
I, CHERRY MAE L. CAMPOSANO , a resident of BLK O LOT 153 SCANDINAVIAN VILLAGE , whose name and
signature appear below, hereby bind myself and declare under oath:
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ______, 20__ at
______________________, Province of _____________________.
SUBSCRIBED AND SWORN to before me this ____ day of _______ at ______________________, Philippines.
Election Officer
Signature over Printed Name
BRING THIS FORM TOGETHER WITH THE APPLICATION FORM
TO YOUR LOCAL COMELEC OFFICE
Reference No. : CEF13747018-29000900202122778902 Generated on 22 September 2021 00:29 (Philippine Standard Time)
Thank you for using the COMELEC iRehistro Online Application Form.
Please bring the printed copy of your accomplished application form, together with the required documents, to your local
COMELEC Office, which is in
TACLOBAN CITY, LEYTE.
1. PLEASE REMEMBER that accomplishing this online form DOES NOT mean that you are already a registered voter.
You still have to go through the following:
a. Go to your local COMELEC office to personally submit your Application Form. (This completes the process of
submission of your application)
b. The Election Registration Board (ERB) has to approve your application.
2. PRINTING REMINDERS :
a. Be sure to print your accomplished form on a folio size (long) bond paper (8-1/2" x 13") and that the four (4) QR
codes are printed clearly and completely. If not, please reprint.
b. Make sure that you have printed the PERSONAL INFORMATION page at the back of the CEF-1 page. If not,
please reprint for compliance.
3. Do not sign or affix your thumbmark on the Application Form yet. (You have to do this in the presence of the Election
Officer when you go to the local COMELEC Office for filing purposes.)
4. PLEASE BRING ANY OF THE FOLLOWING VALID IDs : Employee's identification card (ID), with the signature of the
employer or authorized representative; Postal ID; PWD Discount ID; Student's ID or library card, signed by the ID; Integrated
Bar of the Philipines (IBP) ID; License issued by the Professional Regulatory Commission (PRC); Certificate of Confirmation
issued by the National Commission on Indigenous Peoples (NCIP) in case of members of ICCs or IPS; School authority;
Senior Citizen's ID; Driver's license; NBI clearance; Passport; SSS/GSIS and any other valid ID.
5. For other registration-related queries, you may send an e-mail to registration@comelec.gov.ph or call (02) 525-5692
and (02) 525-4929.